Submitted by  P. Tareyl Barton, MD`` COGBF Healthy Living Contributor          

DEFINITION:

Menopause by definition is no menstrual cycle for 12 months due to decreasing ovarian function.  The decrease in ovarian function can be caused by several factors: including surgical (removal of the ovary), medical (certain prescriptions) or physiologic (normal aging).  The average age in the United States is 51 years.  There are laboratory indicators of menopause as well.  An FSH greater than 40 mIU/ml or an estradiol less than 20 pg/ml will also confirm menopause.  The definition of menopause is not based on symptoms.

SYMPTOMS:

There are 3 categories of symptoms associated with menopause:   VASOMOTOR SYMPTOMS,  UROGENITAL SYMPTOMS &  PSYCHOLOGICAL SYMPTOMS. The vasomotor symptoms include hot flushes &  sleep interruptions.  The urogenital symptoms include vaginal dryness, dyspareunia (painful sexual intercourse & urethral irritation.  The psychological symptoms include mood swings, insomnia, libido changes and concentration difficulties.

PHYSICAL SIGNS:

There is an increase in heart disease, increase in bone loss (including teeth), urogenital atrophy, skin atrophy, impaired cognitive function (memory) and increase risk of colon cancer. 

The consequences of long term estrogen loss include:

1. Osteoporosis (bone loss and tooth loss)
2. Cardiovascular Disease (change in levels of good cholesterol to bad cholesterol)
3. Dementia of the Alzheimer’s Type
4. Cancer (colon)

TREATMENT OPTIONS:  Hormones or No Hormones?

If you choose no hormones, the least interventional, most conservative options to try first are LIFESTYLE CHANGES.  Lifestyle changes to alleviate the symptoms of menopause include wear cool clothing, stop tobacco use, decrease alcohol, regular exercise and weight loss.  Adequate nutrition is also recommended, ESPECIALLY  to include calcium and vitamin D.  Often stress reduction techniques are quite beneficial such as meditation and yoga.

MEDICAL TREATMENTS FOR SYMPTOMS of MENOPAUSE

Hormones

1. ESTROGEN therapy alone (if uterus is absent)
2. Combination ESTROGEN/PROGESTERONE therapy (if uterus is present)
3. PROGESTERONE therapy (oral, injection or Progesterone IUD) 
4. Alternative Medicine Therapy (phytoestrogens, Black cohosh, Clonidine, Gabapentin)

The FDA indications for HORMONE THERAPY are treatment of vasomotor symptoms, treatment of vaginal atrophy and for osteoporosis prevention.  The FDA recommends lowest dose of medication, and the shortest duration to achieve the desired effect.  The indications for treatment are hot flushes, vulvar-vaginal atrophy and osteoporosis treatment. 

The American College of OBSTETRICS & GYNECOLOGY (ACOG) states hormone therapy is not a UNIVERSAL recommendation.  The goals of treatment are lowest effective dose, the shortest tolerable time and to treat the disturbing vasomotor symptoms, including atrophic vaginal changes.  ACOG recommends to only use Hormone Therapy for the length of time necessary to decrease or eliminate symptoms.  The benefits and risks must be weighed on an individual basis. 

There are specific ESTROGEN effects.  

GOOD	BAD
Strengthens bones	Increases breast cancer risk
Raises HDL cholesterol,	Increases uterine cancer risk
Reduces menopausal symptoms (hot flushes)	Increases blood clot risk
Lowers LDL cholesterol

 

The side effects of HORMONE REPLACEMENT THERAPY that many women experience include:

• Uterine bleeding
• Breast Tenderness
• Nausea
• Abdominal bloating
• Fluid retention in arms and legs
• Hair loss
• Headache
• Dizziness

The BENEFITS of HORMONE THERAPY, Quality of Life  Issues

• To decrease vasomotor symptoms
• To decrease mood changes
• Improves sleep quality, decreases number of hot flushes with awakenings per night
• Improves sexual function
• Improves urogenital symptoms
• Improves skin changes

Only use hormone therapy for the length of time necessary to decrease or eliminate symptoms. The benefits and risks must be weighed on an individual basis.